Kenichi Namba1, Hiroshi Takase2, Yoshihiko Usui3, Fumihiko Nitta4, Kazuichi Maruyama5, Sentaro Kusuhara6, Masaki Takeuchi7, Atsushi Azumi8, Ryoji Yanai9, Yutaka Kaneko10, Eiichi Hasegawa11, Kei Nakai12, Hidekazu Tsuruga13, Kazuo Morita13, Toshikatsu Kaburaki14,15. 1. Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan. knamba@med.hokudai.ac.jp. 2. Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan. 3. Department of Ophthalmology, Tokyo Medical University Hospital, Tokyo, Japan. 4. Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan. 5. Department of Vision Informatics, Graduate School of Medicine, Osaka University, Osaka, Japan. 6. Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan. 7. Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan. 8. Ophthalmology Department, Kobe Kaisei Hospital, Kobe, Japan. 9. Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Ube City, Japan. 10. Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan. 11. Department of Ophthalmology, Kyushu University Graduate School of Medicine, Fukuoka, Japan. 12. Department of Ophthalmology, Yodogawa Christian Hospital, Osaka, Japan. 13. AbbVie GK, Tokyo, Japan. 14. Department of Ophthalmology, University of Tokyo School of Medicine, Tokyo, Japan. 15. Department of Ophthalmology, Jichi Medical University Saitama Medical Center, Saitama, Japan.
Abstract
PURPOSE: Non-infectious uveitis associated with Vogt-Koyanagi-Harada (VKH) disease or sarcoidosis is commonly treated with systemic corticosteroids (SCS). We assessed the use of SCS for non-infectious uveitis relapses in Japanese clinical practice. STUDY DESIGN: Multicenter, retrospective chart review (UMIN Clinical Trial Registry; UMIN000032390). METHODS: One hundred fifty-seven patients (15- ≤ 75 years; 103 VKH disease, 54 sarcoidosis) given SCS to treat a relapse of non-infectious intermediate, posterior, or panuveitis accompanying VKH disease or sarcoidosis were studied (August 2011-December 2018). SCS dose and duration, concomitant medications, subsequent relapses, and steroid-related adverse drug reactions (ADRs) were analyzed for 12 months after target relapse treatment. Relationships between background factors and total SCS dose were analyzed (logistic regression). RESULTS: Mean (± SD) total SCS dose over 12 months after target relapse treatment was 3874 ± 2775 mg, and was higher in patients with immunosuppressants than in those without (4575 mg vs 3496 mg). Immunosuppressant use was the only factor significantly associated with higher total SCS dose (p = 0.0196). Mean duration of SCS treatment for relapse was 318.7 ± 89.3 days. Only 29.3% of patients were steroid-free after 12 months; the percentage was higher in patients without immunosuppressants (36.3% vs 16.4%). Subsequent relapse was experienced by 39.5% of patients, and 13.4% had a steroid-related ADR (mostly glaucoma or diabetes). CONCLUSION: In Japanese clinical practice, many patients with recurrent uveitis accompanying VKH disease or sarcoidosis received SCS for relapse for ≥ 300 days, suggesting that reducing corticosteroids is challenging in patients with difficulty suppressing inflammation.
PURPOSE: Non-infectious uveitis associated with Vogt-Koyanagi-Harada (VKH) disease or sarcoidosis is commonly treated with systemic corticosteroids (SCS). We assessed the use of SCS for non-infectious uveitis relapses in Japanese clinical practice. STUDY DESIGN: Multicenter, retrospective chart review (UMIN Clinical Trial Registry; UMIN000032390). METHODS: One hundred fifty-seven patients (15- ≤ 75 years; 103 VKH disease, 54 sarcoidosis) given SCS to treat a relapse of non-infectious intermediate, posterior, or panuveitis accompanying VKH disease or sarcoidosis were studied (August 2011-December 2018). SCS dose and duration, concomitant medications, subsequent relapses, and steroid-related adverse drug reactions (ADRs) were analyzed for 12 months after target relapse treatment. Relationships between background factors and total SCS dose were analyzed (logistic regression). RESULTS: Mean (± SD) total SCS dose over 12 months after target relapse treatment was 3874 ± 2775 mg, and was higher in patients with immunosuppressants than in those without (4575 mg vs 3496 mg). Immunosuppressant use was the only factor significantly associated with higher total SCS dose (p = 0.0196). Mean duration of SCS treatment for relapse was 318.7 ± 89.3 days. Only 29.3% of patients were steroid-free after 12 months; the percentage was higher in patients without immunosuppressants (36.3% vs 16.4%). Subsequent relapse was experienced by 39.5% of patients, and 13.4% had a steroid-related ADR (mostly glaucoma or diabetes). CONCLUSION: In Japanese clinical practice, many patients with recurrent uveitis accompanying VKH disease or sarcoidosis received SCS for relapse for ≥ 300 days, suggesting that reducing corticosteroids is challenging in patients with difficulty suppressing inflammation.